Provider Demographics
NPI:1467506444
Name:PORAZIK, PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PORAZIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22351 BARBACOA DR
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2249
Mailing Address - Country:US
Mailing Address - Phone:661-296-9240
Mailing Address - Fax:
Practice Address - Street 1:2045 LEBEC ROAD
Practice Address - Street 2:
Practice Address - City:LEBEC
Practice Address - State:CA
Practice Address - Zip Code:93243
Practice Address - Country:US
Practice Address - Phone:661-245-1434
Practice Address - Fax:661-245-2730
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice